Archive for the ‘Minimally invasive therapy’ Category

Benign Prostate Enlargement (BPH) – Help Is Available

October 10, 2014

Millions of middle age men suffer from non-cancerous prostate gland enlargement. The cause is not known but is probably related to hormonal changes that occur normally in men after age 50.

The symptoms are going to the bathroom frequently, urgency of urination, poor stream, dribbling after urination. However, the most bothersome symptom that impacts a man’s quality of life is getting up multiple times during the night to go to the restroom.

Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties, and as many as 90% in their seventies and eighties, have some symptoms of BPH. Moreover, because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than conventional surgery.

Thus, BPH is an age-related condition like many others, such as memory deficiency, reduced bones density and muscles flexibility.

As for natural treatment options, it has been noted Saw palmetto, a popular herbal therapy among men with prostate symptoms, is not effective and more and more scientific studies are showing that saw palmetto has no benefits in the treatment of BPH.

There are oral medications such as alpha-blockers such as Flomax and Rapaflo that relax the muscles in the prostate and make it easier for the bladder to empty the contents from the bladder. There are also medications that reduce the size of the prostate gland. These drugs, Proscar and Advodart, actually help decrease the size of the prostate thus decreasing the resistance to the flow of urine from the bladder to the outside of the body. Unfortunately, these drugs have mild side effects and since so many Americans are polymedicated, and alternative solutions are often more attractive to active middle aged men.

Minimally invasive treatments

Men with enlarged prostate glands have symptoms of going to the bathroom frequently, dribbling after urination, and getting up at night to go to the bathroom. The problem is usually caused by a benign enlargement of the prostate gland, which blocks the flow of urine from the bladder to the outside of the body. The cause of the benign enlargement is not known but is probably related to alternations in the hormones, testosterone, of middle aged and older men. Treatment usually consists of medications, alpha-blockers and medications to actually relax the muscles in the prostate gland but these are often ineffective especially if used for long period of time. The other options include minimally invasive procedures such as microwaves that can actually shrink the prostate gland. Now there’s a new treatment option that can be done in the doctor’s office under a local anesthetic.

What are some of the minimally invasive treatments available for BPH?

Laser vaporization: Anesthesia is usually required for this procedure, but patients can usually go home the same day. The technology involves placing a “cystoscope” (metal tube through which the visual lens and laser can be passed). A laser is used to burn and vaporize the obstructing or blocking prostatic tissue. Studies to date have shown limited long-term benefits.

Microwave thermotherapy of the prostate (TUMT): This is an office-based procedure performed with topical and oral pain medication and does not require a general anesthesia. Computer-regulated microwaves are sent through a catheter to heat portions of the prostate. A cooling system is required in some types for better tolerance. Traditionally, the best use of this procedure has been for patients who have too many medical problems for more invasive surgery or for patients who truly wish to avoid any type of anesthesia. Benefits are that there is no need for anesthesia and there is no blood loss or fluid absorption (these would be significant benefits in a person with a weak heart). Patients usually go home the same day. Men may need a catheter for one or two days after the procedure.

The UroLift system, made by NeoTract Inc. of Pleasanton, Calif., is the first permanent implant to relieve low or blocked urine flow in men age 50 and older with an enlarged prostate.

By pulling back prostate tissue that presses on the urethra, the system allows more natural urine flow.   This procedure is compared to pulling back the curtains with a sash. The procedure can be done in the doctor’s office under a local anesthetic and will actually open up the urethra to allow the flow of urine and reduce the urinary symptoms of frequency of urination, improve the force and caliber of the urine stream, and decrease the number of times a man needs to get up at night to empty his bladder.

Of course with any procedure there may be side effects and complications. Some b patients reported pain or burning during urination, increased urgency, decreased urine flow, incomplete bladder emptying, and blood in the urine. Most of these symptoms and side effects were temporary and resolved a few days or weeks after the UroLift was performed.

Bottom Line: Millions of American men suffer from symptoms as a result of an enlarged prostate gland. Certainly medications are a first line treatment option. However, the UroLift may be a permanent solution to this common problem and help men get a good night’s sleep!

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Prostate Gland Enlargement-A New Minimally Invasive FDA Approved Treatment

June 18, 2014

Most men experience benign enlargement of the prostate gland that causes symptoms of difficulty with urination, dribbling after urination and getting up multiple times at night to urinate. All of these symptoms can impact a man’s quality of life.
Enlargement of the prostate gland occurs naturally as men age. Unfortunately, this process can press on the urethra and result in some frustrating side effects including urination and bladder problems. The good news is that an enlarged prostate is benign (not cancerous) nor will it increase your risk of prostate cancer; for these reasons it is often referred to as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.

The exact cause of BPH is unknown; however, a common hypothesis points to changes in the balance of the sex hormones during the aging process. The testicles may also play an important role in prostate growth: for example, men who have had their testicles removed (i.e. as a result of testicular cancer) do not develop BPH. Furthermore, men who have their testicles removed after having developed BPH will experience a decrease in prostate size.
Medications

Prescription drugs are typically the first line of treatment for BPH. Alpha blockers are typically associated with high blood pressure, but in the case of BPH, act by relaxing the muscles in both the bladder neck and prostate, resulting in effortless urination. The effects of alpha blockers are typically seen very quickly (in about a day or two). Some well-known examples are drugs like Rapaflo or Flomax.

Another set of medications, 5 alpha reductase inhibitors, reduce the size of the prostate, thus reducing the pressure on the urethra. Examples of these are Avodart or Proscar. Often, improvements are not seen for a couple of weeks or even months. Common side effects include decreased sex drive and erectile dysfuction. Combination therapy of alpha blockers and 5 alpha reductase inhibitors can be more effective than either drug alone. Antibiotics may also be prescribed to treat prostatitis (prostate inflammation) which can accompany BPH.

Minimally Invasive Procedures
GreenLight Laser uses a high-powered laser combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. The heat of the laser also cauterizes blood vessels, resulting in minimal bleeding. It is an out-patient procedure that involves catheterization for about two days. Stents can be placed in the urethra to help keep it open and allow urine to flow easier. These stents must be replaced every four to six weeks, and as such, are not considered a long term treatment option.

Now a new treatment, the Urolift, has been approved by the FDA and is a minimally invasive treatment that can be done in the doctor’s office under a local anesthetic with immediate results after a 20-30 minute procedure. The procedure consists of inserting two to four implants that opens the urethra directly by retracting the obstructing prostatic lobes without cutting, heating, or removing prostate tissue. The implants pushes aside the obstructive prostate lobes like opening window curtains. Small permanent UroLift implants are deployed, holding the lobes in the retracted position, and thus opening the urethra while leaving the prostate intact. Patients report marked improvement in symptoms immediately after the procedure. There is no problems with erections after the procedure.

Prostate, shown in yellow, with blockage of the urethra

Prostate, shown in yellow, with blockage of the urethra


4 pins in the prostate open the gland and allow improvement in urinary symptoms

4 pins in the prostate open the gland and allow improvement in urinary symptoms

Surgical Procedures
If medications are not effective, or if your prostate is too large, surgical intervention may be necessary. Transurethral resection of the prostate (TURP), or the modified Button TURP, involves the removal of portions of prostate which block urine flow. Hospital stay is typically one day with a two-day catheterization. Reserved for those with unbearable BPH symptoms and extremely large prostates, prostatectomy is the complete removal of the prostate gland. It is more invasive than either TURP or GreenLight Laser, and usually has a higher risk of complications and side effects and requires a longer catheterization. For these reasons, prostatectomies are typically not recommended for those with BPH, but rather the go to surgical intervention for men diagnosed with prostate cancer.
Bottom Line: Prostate enlargement affects nearly 14 million American men mostly after age 50. There are many treatment options available for BPH: medications, minimally-invasive procedures and surgery. Which treatment option is best for you depends on your overall treatment goals, the size of your prostate, your symptoms, your age, and your overall health. Make sure you speak with your doctor about the different treatment options; your doctor will recommend treatments based on your symptoms and treatment goals.

When Things Are Coming Out “Down There”-Pelvic Organ Prolapse

December 25, 2010

Pelvic organ prolapse is a common that affects more than 30 million American women in the United States.  Unfortunately, only 15% of women who have prolapse seek treatment from a doctor.  This article will define prolapse, discuss the symptoms of prolapse and discuss some of the treatment options.

Pelvic organ prolapse is a condition where there is a weakening of the support tissues or muscles of the pelvis.  The symptoms of POP include a bulge or lump in the vagina or a pulling or stretching sensation in the groin.  Women with POP may complain of difficulty with sexual intimacy.  They may also have urine and\or fecal incontinence.  They may also have difficulty with bowel movements or difficulty emptying their bladder.

The causes of POP include menopause, multiple pregnancies and childbirth, prior pelvic surgery, obesity, and as a consequence of the aging process.

Treatment options for POP

Conservative therapies including strengthening the pelvic floor muscles.  This can be easily accomplished with Kegel exercises.  These are exercises named after the doctor who devised the treatment, which consists of contracting and relaxing the muscles in the pelvis.  These are the same muscles which hold urine in and rectal gas in place.  A woman should do the Kegel exercises multiple times a day and should not expect any changes for several months until the muscles are strengthened.

For more information on Kegel exercises go to http://www.neilbaum.com/pelvic-exercises-for-women-kegel-exercises.html.

Another conservative therapy is the use of pessaries or plastic or rubber rings which are inserted into the vagina to restore the fallen organ back into the normal anatomic position.   Peccaries will work immediately but they have to be changed periodically in order to avoid vaginal infections.

Probably the most common treatment is surgical repair of the prolapse.  The surgery is used to strengthen structures around the vagina to maintain support of the structures and organs in the pelvis.  These procedures can usually be accomplished through the vaginal opening.  Most women can have the procedure on a one-day stay basis or remain in the hospital for just 24 hours.  Most women need little or no pain medication after the procedure and can return to all activities including heavy lifting, exercise, and sexual intimacy in 3-4 weeks after the procedure.

Most of the surgical procedures that restore the normal anatomy are 90% successful and most patients are very satisfied after the procedure.

Bottom Line:  If something isn’t right “down there” you don’t have to suffer in silence.  There are several treatment options to restore your normal anatomy.  You can have an improved quality of life and return to your normal activities within a short time.  If you have any questions, call your doctor.

 

 

 

 

Living With Prostate Gland Enlargement-Lifestyle Changes

April 26, 2010

Prostate enlargement or benign prostate hyperplasia (BPH) is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.

The symptoms of prostate gland enlargement include decrease in the force and caliber of the urinary stream, frequency or urination, urgency, feeling of not emptying the bladder and nocturia or the need to get up at night to urinate.

Although lifestyle changes will not cure the problem, they can alleviate some of the symptoms.

Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your condition from worsening. Try these measures:

Remember what goes in must come out.  Therefore don’t drink anything several hours before you go to sleep.  Especially avoid caffeinated beverages such as coffee (also causes insomnia) and tea as the caffeine acts as a diuretic and causes increased urine output that may result in getting up at night to empty your bladder,

Limit your alcohol consumption especially at the dinner meal.  Again alcohol acts as a diuretic causing increased production of urine causing your bladder to fill up sooner than you would like.

Avoid spicy foods.  These appear to irritate the bladder and can result in urinary frequency and nighttime voiding.

Check your medications.  Some medications like lasix and hydrochlorothiazide are diuretics and increase urine production.  I suggest you take those medications early in the day when going to the bathroom to urinate is not such an inconvenience.  You may also speak with your doctor about lowering the dosage of the diuretic especially the evening dose if you are bothered by nighttime urination.

Avoid antihistamines and decongestants as these cause the bladder to decrease the force of contraction and results in the bladder not to empty as well.  If you have to take anti-histamines, use them earlier in the day.

Don’t hold off going to the restroom.  This habit distends the bladder and can result in a weaker muscle to expel the urine from the bladder.

Use the clock to help with urination.  If you find that you are going to the bathroom infrequently and then more at night, make an effort to urinate every 3-4 hours.  Putting your bladder on a schedule is very helpful and a good habit to have.

Go and then go again.  Double voiding is a technique to ensure adequate emptying of the bladder.  If you stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again.  This helps to expel more urine from your bladder than just standing there one time and voiding.

Avoid cold seats such as at football games in the winter.  The cold temperature seems to cause the muscles around the prostate gland to contract and makes urination difficult.  Instead take a blanket or a cushion. Your prostate gland will be glad that you did.

If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland.  Also consider using a seat that has a groove down the middle which alleviates the pressure on your prostate gland.

Bottom Line: These steps won’t cure the enlarged prostate but they will lessen the symptoms.  If they don’t help, see your doctor for medication one of the treatments that reduces the obstruction of your prostate gland.

Treatment of the Enlarged Prostate Gland With Laser Therapy

April 25, 2010

The prostate gland is a walnut sized organ below the bladder, which surrounds the urethra.  For reasons not completely understood, the prostate gland begins to grow around age 50 and causes symptoms affecting urination.  The enlarged prostate gland is a non-cancerous condition that affects nearly 14 million men over age 50.

The symptoms of the enlarged prostate include frequency of urination, getting up at night to urinate, urgency to urinate, decrease in the force and caliber of the urine stream and feeling that the bladder is not emptying.

The treatment for enlarged prostate includes medication to shrink the prostate gland or to relax the muscles in the prostate to relieve the obstruction.  Surgical therapy includes transurethral resection of the prostate (TURP) or open surgery for very large prostate glands. Recently laser therapy has become available for treating the enlarged prostate gland and is considered minimally invasive therapy.

Laser therapy is a procedure performed with a small fiber that is inserted into the urethra, the tube in the penis that allows urine to go from the bladder to the outside of the body.  The fiber delivers high-powered laser energy, which quickly heats the prostate tissue, which causes the tissue to dissolve or vaporize.  This process is continued until all of the enlarged prostate tissue has been removed. The end result is a wide-open channel for urine to pass through the urethra.

Laser therapy can be performed in a hospital outpatient center or an ambulatory treatment center.  Usually no overnight stay is required.  However, in some cases when a patient comes from a great distance, has associated medical problems such as heart disease, diabetes, or severe hypertension, or is in frail condition, an overnight stay may be recommended.

After the procedure

Most men will go home within a few hours after treatment. If a tube or catheter was inserted after the procedure, it will usually be removed the next day after the procedure.

Most patients experience marked improvement in their urinary symptoms immediately after the procedure.  This improvement typically occurs within the first 24 hours after the procedure.  However, the past medical history, health condition and other factors can influence treatment recovery.

Some men may experience mild discomfort such as slight burring during urination and small amounts of blood in the urine for a week or two.  Also, depending upon the condition of a man’s bladder, he may experience greater frequency and urge to urinate.  This will resolve over time as the bladder adjusts now that the obstruction has been removed.

There is no change in a man’s sexual function after the procedure.  His ability to engage in sexual intimacy after the procedure is unchanged.  Most men can begin sexual activity two weeks after the procedure.  Approximately 25% of men will have a decreased or absence of ejaculation at the time of orgasm.  The fluid is still there but goes backwards into the bladder and passes in the urine the next time the man urinates.

What are the risks of the laser procedure?

Every medical treatment may have side effects.  The same is true for the laser treatment.  The most common side effects include:  blood in the urine, bladder spasms, and urgency of urination.  These symptoms are usually temporary and will subside in a few days or weeks.

Bottom Line: Enlarged prostate gland is a common condition that affects most men after age 50.  Treatment options include medications, surgery and minimally invasive treatment using lasers.  The laser treatment produces a rapid improvement in urine flow, a quick return to normal activities, short or no hospitalization.

Minimally Invasive Therapy For Treating Erectile Dysfunction

March 7, 2010

For many men who suffer from erectile dysfunction (ED) or impotence, the new minimally invasive therapy may be just what the doctor ordered.  Men with ED are traditionally treated with oral medications such as Viagra, Cialis or Levitra.  This successfully works in 80-85% of men, at least for a while.  Then the medications may be less effective especially in men with associated conditions such as diabetes, heart disease, high cholesterol levels, or hypertension.

The next level of treatment may be self-injection therapy using medications that increase the blood supply to the penis.  This consists of using a small needle to inject medication directly into the penis 15-30 minutes before engaging in sexual intimacy.  This medication allows an erection to last for 30-40 minutes.  The other option is to use a vacuum device, which is a long plastic tube, applied to the penis.  The air around the penis is evacuated to create a partial vacuum, which allows blood to rush into the penis that is trapped by the application of a thick rubber band at the base of the penis.

If these treatments don’t work, then the man either gives up on his sex life or agrees to a surgical procedure to insert a penile prosthesis.  The most commonly used prosthesis is an inflatable prosthesis that allows a man to have an erection whenever he wants and the erection will last as long as the man wishes to maintain the erection.  After the man has ended his sexual encounter, he can touch a release button on the prosthesis, and the penis becomes soft or flaccid.  The prosthesis is entirely concealed inside the penis and no one can tell that the man has the prosthesis in place.  The insertion of the prosthesis usually requires a general anesthesia and takes 45-120 minutes to perform.  Most men will stay in the hospital overnight and are discharged the day after the procedure.

Now a new technique, which was developed by a Florida urologist, allows the procedure to be done under local anesthesia in less than 15 minutes.  The whole procedure is done through a small opening 1-2 inches long in the lower abdomen.  Men are able to leave the one-day stay surgical facility in a few hours after the procedure or as soon as the man can urinate.  Most men only require an oral pain pill for a day or two after the procedure.  Men can begin using the prosthesis one to two days after the procedure and most men can begin having sexual intimacy in 3-4 weeks afterwards.  Most insurance companies, including Medicare, pay for the procedure.

Bottom Line: If you are suffering from ED and the oral medications are no longer effective, see your doctor, as you may be a candidate for minimally invasive treatment.  You and your partner will be happy you found a treatment that works for you.

Dr. Neil Baum is a urologist who specializes in the treatment of erectile dysfunction.  He can be reached at 504 891-8454 or via his website, http://www.neilbaum.com